Francesco/who-killed-jfk huggingface dataset:
[104-10222-10042.pdf — page 126]
# ELECTION, DECLINATION, OR WAIVER OF LIFE INSURANCE COVERAGEFEDERAL EMPLOYEES GROUP LIFE INSURANCE PROGRAMTO COMPLETE THIS FORM1 FOLLOW THESE GENERAL INSTRUCTIONS:*   Read the back of the "Duplicate" carefully before you fill in the form.*   Fill in BOTH COPIES of the form. Type or use ink.*   Do not detach any part.2 FILL IN THE IDENTIFYING INFORMATION BELOW (please print or type):NAME (last) (first) (middle) DATE OF BIRTH (month, day, year) SOCIAL SECURITY NUMBERBustos-Videla Charlotte Louise January 12, 1929 069 24 3138EMPLOYING DEPARTMENT OR AGENCY 007667 LOCATION (City, State, ZIP Code)3 MARK AN "X" IN ONE OF THE BOXES BELOW (do NOT mark more than one):Mark here if you WANT BOTH optional and regular insurance[X] (A) ELECTION OF OPTIONAL (IN ADDITION TO REGULAR) INSURANCEI elect the $10,000 additional optional insurance and authorize the required deductions from my salary, compensation, or annuity to pay the full cost of the optional insurance. This optional insurance is in addition to my regular insurance.Mark here if you DO NOT WANT OPTIONAL but do want regular insurance(B) DECLINATION OF OPTIONAL (BUT NOT REGULAR) INSURANCEI decline the $10 000 additional optional insurance. I understand that I cannot elect op- tional insurance until at least 1 year after the effective date of this declination and unless at the time I appay for it I am under age 50 and present satisfactory inedical evidence of insurability. I understand also that my regular insurance is not affected by this declina- tion of additional optional insurance.Mark here if you WANT NEITHER regular nor optional insurance(C) WAIVER OF LIFE INSURANCE COVERAGEI desire not to be insured and I waive coverage under the Federal Employees Group Life Insurance Program, i understand that I cannot cancel this waiver and obtain regulár in- surance until at least 1-year after the effective date of this waiver and unless at the time I apply for insurance I am under age 50 and present satisfactory medical evidence of in- surability. I understand also that I cannot now or later have the $10,000 additional optional insurance unless I have the regular insurance.4 SIGN AND DATE. IF YOU MARKED BOX "A" OR "C", COMPLETE THE "STATISTICAL STUB." THEN RETURN THE ENTIRE FORM TO YOUR EMPLOYING OFFICE.SIGNATURE (do not priatDATE 15 February 1968ORIGINAL COPY-Retain in OfficialFOR EMPLOYING OFFICE USE ONLY(official receiving date stamp)See Table of Effective Oates on back of Origina!STANDARD FORM Ma. 176-TJANJAR 1554(For use only .1.1 Apr 14, 1968)176-131
[104-10222-10042.pdf — page 128]
# QUALIFICATIONS SUPPLEMENT TO PERSONAL HISTORY STATEMENTREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING. TYPE OR PRINT AVOID USING LIGHT COLORED INKS## BIOGRAPHIC AND POSITION DATA1 EJAD SER NO6. 500076672 NAME (Last, First, Middle)BUSTOSYIDELA C Z7 POSITION TITLEOPS OFFICER3 SEXF8 OFFICE OF ASSIGNMENTWH4 DATE OF BIRTH01/12/299 LOCATION (Country, City)MEXICO CITY, MEXICO5 SCHEDULE GRADE/STEPGS-13-06## AGENCY OVERSEAS SERVICEAREANO OVERSEAS SERVICETYPE TOURFROMTOMEXICO CITY STATION1st tour27 JULY 196710 JUNE 19702nd tour1970> OVERSEAS DATA> > DATE: E6 JUN 1971 INITIALS: S## EDUCATIONDEGREEMAJOR FIELDCOLLEGEYEARBACHECONOMICS, GENERALSYRACUSE UNIV NY50
[104-10222-10042.pdf — page 129]
SECRETSECTION D1 PRESENT STATUS: Single Married Widowed Separated Divorced, Annulled Remarried (SPECIFY)2 NAME OF SPOUSEBustes VIDELA3 DATE OF BIRTHFeb 27, 19224 PLACE OF BIRTH (City, State, Country)SAN JUAN ARGENTINA5 OCCUPATIONPROFESSOR6 PRESENT EMPLOYERUNIVERSIDAD DE LAS AMERICAS, Cholula, MEXICO7 CITIZENSHIPUSA (naturalized)8 FORMER CITIZENSHIP(S) COUNTRY(IES)Argentine9 DATE U.S. CITIZENSHIP ACQUIRED1956SECTION X DEPENDENT CHILDREN AND DEPENDENTS OTHER THAN SPOUSE| NAME | RELATIONSHIP | DATE AND PLACE OF BIRTH | CITIZENSHIP | PERMANENT ADDRESS || ---- | ------------ | ----------------------- | ----------- | ----------------- ||      |              |                         |             |                   ||      |              |                         |             |                   ||      |              |                         |             |                   ||      |              |                         |             |                   ||      |              |                         |             |                   ||      |              |                         |             |                   |SECTION XI PROFESSIONAL SOCIETIES AND OTHER ORGANIZATIONS| NAME AND CHAPTER | ADDRESS (Number, Street, City, State, Country) | DATE OF MEMBERSHIP FROM TO |     || ---------------- | ---------------------------------------------- | -------------------------- | --- ||                  |                                                |                            |     ||                  |                                                |                            |     ||                  |                                                |                            |     ||                  |                                                |                            |     ||                  |                                                |                            |     ||                  |                                                |                            |     |DATE22 June 1970SIGNATURE OF EMPLOYEECharlotte & Bustos KueinSECRET.7.
[104-10222-10042.pdf — page 130]
# CERTIFICATION OF LANGUAGE PROFICIENCYEMPLOYEE NO: 2. NAME (LAST-FIRST-MIDDLE)BUSTOS-VIDELA, CHARLOTTE3. TYPE CHANGE:   A - ADD   C - CHANGE   D - DELETE4. LANGUAGE DATA PRIOR TO TESTLAN. CODER  W  P  S  U  I/T YEAR5. LANGUAGE DATA AFTER TEST:   LAN. CODE   R W P S U I/T YEAR6. DATE TESTED10/17/727. DATE OF BIRTH01/12/298. GRADE139. OFFICE OR DIVISIONNHNOTICE TO PERSON TESTED10. ON THE DATE SHOWN IN ITEM 6 ABOVE, YOU WERE TESTED IN SPANISH (NEW WORLD) BL18    AND YOUR TEST SCORES ARE AS FOLLOWS:(NAME OF LANGUAGE)READINGNWRITING+PRONUNCIATION+SPEAKINGI+UNDERSTANDINGHTESTRATINGSQ = ZERO I = INTERMEDIATES = BLIGHT H = HIGHE = ELEMENTARY N = NATIVE11. REMARKSSpeaking grade.12. SIGNATURE*Rly*13. LD NUMBER20723FORM 1273 OBSOLETE PREVIOUS EDITIONG11-64 (110-45)GROUP 41 - OP/QABTHE DATA ABOVE (ITEMS 2 THRU 5) WILL BE FILLED IN WHEN CODING AN APPLICANT FOR THE FIRST TIME. THIS FORM IS THEN ATTACHED TO FORM 1962, MASTER QUALIFICA- TIONS CODING RECORD.4. DATE OF BIRTH   MO DA YR5. DATE CODED   MO DA YRLANGUAGE CODING DATA - FORM 444c1. ID2. EMPLOYEE NO. 3. NAME   3-LETTER4. LANGUAGE DATA CODE   BASE CODE   R W P S U T YR5. DATE SUBMITTED   MO DA YR6. DATE OF BIRTH   MO DA YRWHEN FORM 444c DENOTES NO LANGUAGE COMPETENCE, ENTER THE FOLLOWING IN ITEM 4: "NO++LANGUAGE" (12-DIGITS)LANGUAGE PROFICIENCY TEST DATA1. ID2. EMPLOYEE NO. 3. NAME   3-LETTERSCODEC-A-D5. LANGUAGE DATA BEFORE TEST   BASE CODE   R W P S U T YR`5``007667` *Bus*BL18 1 1 H 1 1 4 677. DATE OF TEST   MO DA YRDATA FOR ITEM 2 THRU 7 IS EXTRACTED FROM FORM 1273. LANGUAGE PROFICIENCY AND AVAROS GATA.6. LANGUAGE DATA AFTER TEST   BASE CODE   R W P S U T YRBL18 N i H i H 4 72 14 17 721. ID2. EMP/APPL NO. 3. NAME   3-LETTERSQUALIFICATIONS RECORD CHANGEENTER UNDER "TYPE":A - ADDITION TO RECORDC - CHANGE TO EXISTING RECORDD - DELETION OF DATA FROM EXISTING RECORDCODE # 1BASE1 2 3 YRCODE # 2BASE1 2 3 YRFORM 1962aSECRET
[104-10222-10042.pdf — page 131]
# SECRET(WHEN FILLED IN)CERTIFICATION OF LANGUAGE PROFICIENCY1. EMPLOYEE NO. 2. NAME (LAST-FIRST-MIDDLE)477667BUSTOS-VIDELA, CHARLOTTE Z.3. TYPE CHANGE   A=ADD   C=CHANGE   D=DELETE4. LANGUAGE DATA PRIOR TO TEST   LAN. CODE R W P S U I/T YEAR5. LANGUAGE DATA AFTER TEST 6. DATE TESTED 7 DATE OF BIRTH 8 GRADE 9. OFFICE OR DIVISIONLAN. CODE R W P S U I/T YEAR06/22/6701/12/29-13 WHNOTICE TO PERSON TESTED10. ON THE DATE SHOWN IN ITEM 6 ABOVE, YOU WERE TESTED IN SPANISH (NEW WORLD) BL18    AND YOUR TEST SCORES ARE AS FOLLOWS:    (NAME OF LANGUAGE)READING WRITING PRONUNCIATION SPEAKING UNDERSTANDING TEST RATINGSQ = ZERO I = INTERMEDIATES = SLIGHT H = HIGHE = ELEMENTARY N = NATIVEI CODED R I I.12. SIGNATURE11. REMARKSFORQUALIFICATIONSDATE 25 AUGFORM 1273 OBSOLETE PREVIOUS EDITIONS13. LD NUMBER14168(10-45) SECRET1 - OP/QABLANGUAGE PROFICIENCY TEST DATA1. ID 2. EMPLOYEE NO. 3. NAME 4. CODE 5. LANGUAGE DATA BEFORE TEST3-LETTERS C-A-D BASE CODE R W P S U T YR<5477667BLLSC*BL18 H L H H N 46*6. LANGUAGE DATA AFTER TEST 7. DATE OF TEST DATA FOR ITEM 2, THRU 7 ISBASE CODE R W P S U T YR MO DA YR EXTRACTED FROM PEAN 127*BL18I I H I I 467 6 22 67LANGUAGE PROFICIENCY ATOAWARDS ДЛГА. 2 OCT 1967QUALIFICATIONS RECORD CHANGE1. ID 2. EMP/APPL NO. 3. NAME ENTER UNDER "TYPE" -3-LETTERS A - ADDITION TO RECORDC - CHANGE TO EXISTING RECORD<4*B* - CELETION OF DATA FROM EXISTING RECORDTYPE CODE #1 CODE #2BASE 1 2 3 YR BASE 1 2 3 YRFORM 1962aSECRET
[104-10222-10042.pdf — page 132]
SECRET(When Filled In)# LANGUAGE PROFICIENCY AND AWARDS DATA1. PERSONNEL STWAL NO (1-6)2. 10 NO3. NAME (7-24) LAST FIRST MIDDLEColunt, Carlotte4. OFFICE OR DIVISION5 LANGUAGE6 LANG CODE (25-27)7707. DATE OF TEST (40-31)8 ANNIVERSARY DATE9 GRADE10 DATEOct 11, 20Oct 11, 2112June 12, 190011. REASON FOR TAKING TESTAPPLY FOR AWARD12. TEST SCORESREADING (34)WRITING (35)PRONUNCIATION (36)SPEAKING (37)UNDERSTANDING (38)ESTABLISH SATLL LEVELHIIIYH13. ELIGIBRITY (30)14. TYPE OF AWARDA ACHIEVEMENT (A) ELEMENTARY (E)READING (R) SPEAKING (S)BASED ON TRAINING THAT WASDIRECTED (D) OR VOLUNTARY (V)M MAINTENANCE (M) INTERMEDIATE (I)COMPREHENSIVE (C)NA (N) HIGH (H)E-I15. INELIGIBLE (REASON)16. I CERTIFY THIS EMPLOYEE FOR A PROFICIENCY AWARD OF $ 100.00 (40-45)SIGNATUREDATE17 I CERTIFY THAT FUNDS ARE AVARABLEOBLIGATION REF. NO.CHARGE ALLOTMENT NO.REMARKSSIGNATUREFORM 1273 OBSOLETE PREVIOUS560 EDITIONSSECRETMRD COPY
[104-10222-10042.pdf — page 133]
# SECRETPERIODIC SUPPLEMENTPERSONAL HISTORY STATEMENTTHIS DATE10 Septemier 1957This form provides the means whereby your official personnel records will be kept current. Even though if duplicates information you have furnished previously, it will be necessary for you to complete sections I through VII entirely. You need complete sections I through VII only if there has been a change since you entered on duty with the organization or if you believe the item requires more complete coverage than you have previously reported.## SECTION I1. FULL NAME (Last-First-Middle)   ZEHRUNG, Charlotte L.2. CURRENT ADDRESS (No., Street, City, Zone, State)   GENERAL3. PERMANENT ADDRESS (No., Street, City, Zone, State)   3817 Davis Place, N. W., Washington 5536 South Dixie Highway, Dayton 9, Ohio4. HOME TELEPHONE NUMBER   Em 2-16189. STATE, TERRITORY, POSSESSION OR COUNTRY IN WHICH YOU NOW CLAIM RESIDENCE   Ohio## SECTION IIPERSON TO BE NOTIFIED IN CASE OF EMERGENCY1. NAME (Last-First-Middle) PREFERABLY RESIDING IN U.S.2. RELATIONSHIP   ZEHRUNG, Samuel Daniel   Father3. HOME ADDRESS (No., Street, City, Zone, State, Country)   5536 South Dixie Highway, Dayton 9, Ohio4. BUSINESS ADDRESS (No., Street, City, Zone, State, Country) INDICATE NAME OF FIRM OR EMPLOYER, IF APPLICABLE   5536 South Dixie Highway, Dayton 9, Ohio. San Rae Gardens5. HOME TELEPHONE NUMBER   NO 3-35116. BUSINESS TELEPHONE NUMBER   NO 3-35117. BUSINESS TELEPHONE EXTENSION   None9. IN CASE OF EMERGENCY, OTHER CLOSE RELATIVES (Spouse, Mother, Father) MAY ALSO BE NOTIFIED. IF SUCH NOTIFICATION IS NOT DESIRABLE BECAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE.## SECTION IIIMARITAL STATUS[Figure: Checkboxes indicating marital status: Single, Married, Widowed, Separated, Divorced, Annulled]FURNISH PLACE AND REASON FOR SEPARATIONS, DIVORCES OR ANNULMENTSSPOUSE: If you have been married more than once, including annulments, use a separate sheet for former wife or husband giving date below for all previous marriages. If marriage is contemplated, provide same data for fiance.3. NAME (Last)4. DATE OF MARRIAGE5. PLACE OF MARRIAGE (City, State, Country)6. ADDRESS OF SPOUSE BEFORE MARRIAGE (No., Street, City, State, Country)7. LIVING8. DATE OF DEATH9. CAUSE OF DEATH10. CURRENT ADDRESS (Give last address, if deceased)11. DATE OF BIRTH12. PLACE OF BIRTH (City, State, Country)13. IF BORN OUTSIDE U.S., DATE OF ENTRY14. PLACE OF ENTRY15. CITIZENSHIP (Country)16. DATE ACQUIRED19. OCCUPATION19. PRESENT EMPLOYER (Also give last employer, if not employed, or if spouse is deceased or unemployed, list two employers).20. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State, Country)SECTION III CONTINUED TO PAGE 2SECRET1![FOR QUALIFICATIONS Date 11 JUN 1958]
[104-10222-10042.pdf — page 134]
# SECRET(When Filled In)SECTION III CONTINUED FROM PAGE 111. DATES OF MILITARY SERVICE OF SPOUSE (From    and To) BY MONTH AND YEAR12. BRANCH OF SERVICE13. COUNTRY WITH WHICH MILITARY SERVICE WAS14. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGNSECTION IV RELATIVES BY BLOOD, MARRIAGE OR ADOPTION LIVING ABROAD OR WHO ARE NOT U.S. CITIZENS1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. AGE4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES5. CITIZENSHIP (Country)6. FREQUENCY OF CONTACT7. DATE OF LAST CONTACT1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. AGE4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES5. CITIZENSHIP (Country)6. FREQUENCY OF CONTACT7. DATE OF LAST CONTACT1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. AGE4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES5. CITIZENSHIP (Country)6. FREQUENCY OF CONTACT7. DATE OF LAST CONTACT1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. AGE4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES5. CITIZENSHIP (Country)6. FREQUENCY OF CONTACT7. DATE OF LAST CONTACT5. SPECIAL REMARKS. IF ANY, CONCERNING THESE RELATIVESSECTION V FINANCIAL STATUS1. ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY?   [x] YES   [ ] NO2. DO YOU HAVE ANY FINANCIAL INTEREST IN, OR OFFICIAL CONNECTION WITH, NON-U.S. CORPORATIONS OR BUSINESSES OR IN OR WITH U.S. CORPORATIONS OR BUSINESSES HAVING SUBSTANTIAL FOREIGN INTEREST?   [ ] YES   [x] NO   IF YOU HAVE ANSWERED "YES," GIVE COMPLETE DETAILS ON A SEPARATE SHEET AND ATTACH IN A SEALED ENVELOPE.3. DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT ACT, PENSION, OR COMPENSATION FOR MILITARY OR NAVAL SERVICE?   [ ] YES   [x] NO4. IF YOU HAVE ANSWERED "YES" TO QUESTION 3 ABOVE, GIVE COMPLETE DETAILS.5. WITHOUT REFERENCE TO YOUR SALARY, STATE OTHER SOURCES OF RECURRENT INCOME NOT INDICATED BY PRECEDING ITEMS.SECTION V CONTINUED TO PAGE 3SECRET2
[104-10222-10042.pdf — page 135]
SECRETSECTION V CONTINUEDNAME OF INSTITUTION BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS: ADDRESS (City, State, Country)Citizens Federal Savings & Loan Assn. Dayton, OhioRiggs National Bank Washington, D. C.7. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY? YES NO8. IF YOU HAVE ANSWERED “YES” TO QUESTION 7 ABOVE, GIVE PARTICULARS, INCLUDING COURT AND DATE(S):SECTION VI CITIZENSHIP1. COUNTRY OF CURRENT CITIZENSHIP 2. CITIZENSHIP ACQUIRED BY CHECK (X) ONE:   US BIRTH [X] NATURALIZED OTHER (Specify)3. HAVE YOU TAKEN STEPS TO CHANGE YOUR 4. GIVE PARTICULARS:   PRESENT CITIZENSHIP?5. IF YOU HAVE APPLIED FOR U.S. CITIZENSHIP, INDICATE PRESENT STATUS OF YOUR APPLICATION (First papers, etc.)SECTION VII EDUCATION1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINED:LESS THAN HIGH SCHOOL GRADUATE NEVER ATTENDED COLLEGE - NO DEGREEHIGH SCHOOL GRADUATE BACHELOR’S DEGREETRADE, BUSINESS, OR COMMERCIAL SCHOOL GRADUATE GRADUATE STUDY LEADING TO HIGHER DEGREETWO YEARS COLLEGE OR LESS MASTER’S DEGREE DOCTORATE DEGREE2. COLLEGE OR UNIVERSITY STUDY:NAME AND LOCATION OF COLLEGE OR UNIVERSITY SUBJECTS DATES ATTENDED DEGREE DATE SEM/QTR HRS.MAJOR MINOR FROM TO REC’D REC’D COMPLETED(Specify)3. TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS:NAME OF SCHOOL STUDY OF SPECIALIZATION DATES ATTENDED TOTALFROM TO HOURS4. MILITARY TRAINING (Full time only in specialized schools such as Ordnance, Intelligence, Communications, etc.)NAME OF SCHOOL STUDY OF SPECIALIZATION DATES ATTENDED TOTALFROM TO HOURS5. OTHER EDUCATIONAL TRAINING NOT INDICATED ABOVE:SECRET
[104-10222-10042.pdf — page 137]
# SECRETCHILDREN AND OTHER DEPENDENTSSECTION XII1. NUMBER OF CHILDREN (Including stepchildren and adopted children) WHO ARE UNMARRIED, UNDER 21 YEARS OF AGE, AND ARE NOT SELF-SUPPORTING.2. NUMBER OF OTHER DEPENDENTS (including spouse, parents, stepparents, sister, etc.) WHO DEPEND ON YOU FOR AT LEAST 50% OF THEIR SUPPORT, OR, CHILDRENDERY 12 YEARS OF AGE AND ARE NOT SELF-SUPPORTING.3. PROVIDE THE FOLLOWING INFORMATION FOR ALL CHILDREN AND DEPENDENTS| NAME | RELATIONSHIP | YEAR OF BIRTH | SEX | CITIZENSHIP | ADDRESS   || ---- | ------------ | ------------- | --- | ----------- | --------- ||      |              |               |     |             | MAIL-ROOM ||      |              |               |     |             |           ||      |              |               |     |             |           ||      |              |               |     |             |           ||      |              |               |     |             |           |ADDITIONAL COMMENT AND/OR CONTINUATION OF PRECEDING ITEMS![signature of employee]DATE COMPLETED
[104-10222-10042.pdf — page 138]
# SECRET(When Filled In)1 PERSONNEL SERIAL NO. (1.6)LANGUAGE PROFICIENCY AND AWARDS DATA2. LD NO.3. NAME (7-24)4. COMPONENT5. GRADE6. DATE OF BIRTH7. LANGUAGE8. CODE (25-27)9. DATE OF TEST10. ANNIVERSARY DATE (20-33)TEST SCORES11. TEST PURPOSE12. SPEAKING (37) UNDERSTANDING (38)    13 ELIGIBILITY (30)    READING (34) WRITING (35) PRONUNCIATION (36)    AWARDAPLE    NOT    AWARDAGLE    AWARD    PHILL14. I CERTIFY THIS EMPLOYEE FOR AWARD15. TYPE OF AWARD    SIGNATURE    DATE    A-M    E-I-H    C    R-W-8    D-V16. AMOUNT OF AWARD    $ 100.0017. I CERTIFY THAT FUNDS ARE AVAILABLE    OBLIGATION REF. NO.    SIGNATURE18. FEDERAL TAX DEDUCTION    $20. CHARGE ALLOTMENT NO.    DATE19. STATE/DC TAX DEDUCTION    $22. EMPLOYEE PAYROLL NO.21. NET AMOUNT OF AWARD    $23. FORWARD CHECK TO24. ALLOTMENT OF ASSIGNMENT    DATE25. CHECK NO    FORM    1273 USE PREVIOUS EDITIONS    (10-45) MRD COPYSECRET---# SECRET(When Filled In)1 PERSONNEL SERIAL NO. (1.6)2. LD NO.LANGUAGE PROFICIENCY AND AWARDS DATA3. NAME (7.24)4. COMPONENT5. GRADE6. DATE OF BIRTH7. LANGUAGE8. CODE (25-27)9. DATE OF TEST10. ANNIVERSARY DATE (26.33)    Spanish    TEST SCORES11. TEST PURPOSE12. SPEAKING (37)    UNDERSTANDING (39)13. ELIGIBILITY (30)    READING (34) WRITING (35) PRONUNCIATION (36)    AWARDABLE    NOT    AWARDABLE    AWARD    SKILL14. I CERTIFY THIS EMPLOYEE FOR AWARD15. TYPE OF AWARD    SIGNATURE    DATE    A.M    E-I-H    C    R-W-8    D-V16. AMOUNT OF AWARD    $ 100.0017. I CERTIFY THAT FUNDS ARE AVAILABLE    OBLIGATION REF. NO.    SIGNATURE18. FEDERAL TAX DEDUCTION    $20. CHARGE ALLOTMENT NO.    DATE19. STATE/DC TAX DEDUCTION    $22. EMPLOYEE PAYROLL NO.21. NET AMOUNT OF AWARD    $23. FORWARD CHECK TO24. ALLOTMENT OF ASSIGNMENT    FORM    1273 USE PREVIOUS EDITIONS25. CHECK NO    DATE    SECRET    (10-45) MRD COPY
[104-10222-10042.pdf — page 139]
# SECRETWhen Filled In# LANGUAGE DATA RECORDPART I-GENERAL1076671. NAME (Last-First-Middle)ZEHRUNG, Charlotte Louise2. DATE OF BIRTHJanuary 12 19293. LANGUAGESpanish4. TODAY'S DATEApril 2 19575. I HAVE NO PROFICIENCY IN ANY FOREIGN LANGUAGEPART II-LANGUAGE ELEMENTSSECTION A. Reading (40)1. I CAN READ TEXTS OF ANY DIFFICULTY, OF A GENERAL NATURE OR IN FIELDS I AM FAMILIAR WITH, USING THE DICTIONARY ONLY RARELY.2. I CAN READ TEXTS OF MOST GRADES OF DIFFICULTY, OF A GENERAL NATURE OR IN FIELDS I AM FAMILIAR WITH, USING THE DICTIONARY OCCASIONALLY.3. I CAN READ TEXTS OF AVERAGE DIFFICULTY (newspapers, reference materials, etc.). USING THE DICTIONARY FREQUENTLY.4. I CAN READ SIMPLE TEXTS, SUCH AS STREET SIGNS, NEWSPAPER HEADLINES, ETC., USING THE DICTIONARY FREQUENTLY.5. I HAVE NO READING ABILITY IN THE LANGUAGE.SECTION B. Writing (41)1. I CAN WRITE PERSONAL LETTERS AND SIMILAR MATERIAL WITH COMPLETE SUCCESS WITHOUT USING THE DICTIONARY. I CAN WRITE FACTUAL NARRATIVE AND EXPOSITORY MATERIAL WITH REASONABLE CLARITY, WITH FEW GRAMMATICAL ERRORS, IN A STYLE WHICH MAY NOT BE NATIVE, USING THE DICTIONARY ONLY RARELY.2. I CAN WRITE PERSONAL LETTERS AND SIMILAR SIMPLE MATERIAL WITH COMPLETE SUCCESS, USING THE DICTIONARY ONLY PARTLY. I CAN WRITE FACTUAL NARRATIVE AND EXPOSITORY MATERIAL WITH REASONABLE CLARITY, WITH FEW GRAMMATICAL ERRORS, BUT IN A STYLE WHICH MAY NOT BE NATIVE, USING THE DICTIONARY OCCASIONALLY.3. I CAN WRITE PERSONAL LETTERS AND SIMILAR SIMPLE MATERIAL. WITH REASONABLE SUCCESS IN CONVEYING MY MEANING, BUT WITH OCCASIONAL MINOR GRAMMATICAL ERRORS AND IN OBVIOUSLY FOREIGN, AWKWARD STYLE, USING THE DICTIONARY OCCASIONALLY.4. I CAN WRITE PERSONAL LETTERS AND SIMILAR SIMPLE MATERIAL, WITH REASONABLE SUCCESS IN CONVEYING MY MEANING, BUT WITH MANY GRAMMATICAL ERRORS AND IN A VERY FOREIGN, AWKWARD STYLE USING THE DICTIONARY FREQUENTLY.5. I CANNOT WRITE IN THE LANGUAGESECTION C. Pronunciation (42)1. MY PRONUNCIATION IS NATIVE.2. WHILE NATIVES CAN DETECT AN ACCENT IN MY PRONUNCIATION THEY HAVE NO DIFFICULTY UNDERSTANDING ME.3. MY PRONUNCIATION IS OBVIOUSLY FOREIGN, BUT ONLY RARELY CAUSES DIFFICULTY FOR NATIVES TO UNDERSTAND.4. MY PRONUNCIATION IS OCCASIONALLY DIFFICULT FOR NATIVES TO UNDERSTAND.5. I HAVE NO SKILL IN PRONUNCIATION.CONTINUE ON REVERSE SIDESECRET
[104-10222-10042.pdf — page 140]
CONTINUATION OF PART 11-LANGUAGE ELEMENTSSpeaking (43)SECTION 0.1. I SPEAK FLUENTLY AND ACCURATELY IN ALL PRACTICAL AND SOCIAL SITUATIONS I CONVERSE FREELY AND IDIOMATICALLY IN ALL FIELDS WITH MICH I AM FAMILIAR.2. I SPEAK FLUENTLY AND ACCURATELY IN NEARLY ALL PRACTICAL AND SOCIAL SITUATIONS, I CAN CONVERSE IN MOST FIELDS WITH WHICH I AM FAMILIAR AND I EMPLOY SOME POPULAR SAYINGS, LITERARY QUOTATIONS, AND COMMON PROVERBS.3. I GET ALONG QUITE WELL IN SITUATIONS OF DAILY LIFE AND TRAVEL AND CAN CONDUCT ROUTINE BUSINESS IN PARTICULAR FIELDS4. I MANAGE TO GET ALONG IN THE MOST COMMON SITUATIONS OF DAILY LIFE AND TRAVEL.5. I HAVE NO ABILITY TO USE THE LANGUAGE IN ANY OF THE ABOVE RESPECTS.SECTION E.Inderstanding (14)1. I UNDERSTAND NON TECHNICAL CONVERSATION ON ALL SUBJECTS, BOTH FACE TO PACE AND ON THE TELEPHONE I UNDERSTAND NEARLY EVERYTHING I HEAR ON THE RADIO AND AT THE MOVIES. PLAYS, AND LECTURES.2. I UNDERSTAND NON TECHNICAL CONVERSATION ON NEARLY ALL SUBJECTS, BOTH FACE TO FACE AND ON THE TELEPHONZI I UNDERSTAND MOST OF WHAT I HEAR ON THE RADIO AND AT THE MOVIES, PLAYS, AND LECTURES, INCLUDING MOST JOKES AND PUNS.3. I UNDERSTAND NEARLY ALL CONVERSATION ON TOPICS OF DAILY LIFE AND TRAVEL, DOTH FACE TO FACE AND ON THE TELE PHONE I UNDERSTAND MUCH OF WHAT HEAN ON THE RADIO, AND AT THE MOVIES, PLAYS, AND LECTURES.4. I UNDERSTAND THE SIMPLEST CONVERSATION, BOTH FACE TO FACE AND ON THE TELEPHONE I UNDERSTAND SOME OF WHAT I HEAR ON THE RADIO AND AT THE MOVIES, PLAYS, AND LECTURES.5. I AM NOT ABLE TO UNDERSTAND THE SPOKEN LANGUAGE.BEFORE CONTINUING - CHECK PART 11 TO ENSURE THAT YOU HAVE CIRCLED ONE NUMBER PER SECTION.PART 111-EXPERIENCE AS TRANSLATOR OR INTERPRETER (45)1. I HAVE HAD EXPERIENCE AS A TRANSLATOR.2. I HAVE HAD EXPERIENCE AS AN INTERPRETER.3. BOTH OF THE AHOVE STATEMENTS APPLY.4. NONE OF THE ADUVE STATEMENTS APPLY.PART IV-CERTIFICATIONI CERTIFY THAT THE INFORMATION GIVEN ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. THIS CERTIFICATION CONSTITUTES MY APPLICATION FOR A MAINTENANCE ABARD PROVIDED I AM ELIGIOLE UNDER THE TERMS OF REGULATION NO. 25 115. PAR, IC(4). 12405SAND THAI MUST PASS AN OBJECTIVE LANGUAGE PROFICIENCY FEST BEFORE I UECOME ELIGIBLE FOR AN AWARD, AND THAT JAMESPECTIVE OF THE DATE OF TESTING, ANNUAL MAINTENANCE AWARDS BILL BE CUMULATIVE AS OF THE ANNIVERSARY CATE OF COMPLETING THIS FORM.DATE SIGNED2 April 1957SIGNATURECarlotezearing